Doctors in small practices experience less burnout, study finds

Physicians working in small, independent New York City practices on average showed fewer signs of burnout than all physicians nationwide, according to a new study led by a researcher at NYU School of Medicine. It will be published online today in the Journal of the American Board of Family Medicine.

The study surveyed 235 providers at 174 small, independent practices, finding just 13.5% of respondents said they had experienced burnout. That compares with an average of 54.4% of all doctors surveyed in a national study in 2014.

One explanation is the greater sense of autonomy doctors feel when operating their own practice, said the study's senior author, Dr. Donna Shelley, professor of population health and medicine at NYU School of Medicine.

"It's not that being an independent practice isn't tough," she said. "That is outweighed by the effect of having control over your work environment."

Shelley also noted the strong connection to patients many of the physicians showed. She described one primary care doctor, an African immigrant who speaks multiple languages. About half of his patients were also African immigrants.

"He spoke about it as being satisfying," she said. "He felt if he weren't there, they probably wouldn't go to a doctor."

While the study compares results to a national average, Shelley said, it cannot be used to compare burnout rates at small and large practices, which weren't part of the survey. But it does suggest that medical groups and hospitals should look for ways to give physicians a voice in decision making to improve their job satisfaction.

Independent doctors are increasingly concerned about their ability to keep up as government and private payers demand reporting on quality of care, said Greg Burke, director of innovation strategies at the United Hospital Fund. But Burke's research on strategies that will help independent practices survive found city doctors had similar traits to those demonstrated in the study.

"It reinforces my conviction that there's more to it than money," Burke said of the new research. A United Hospital Fund report published in June suggested providers could share services in areas such as care management, data analytics and behavioral health to improve quality and lower the cost of their care.

The challenge is balancing physicians' desire to share costs with other practices while still maintaining control, Burke said.

"You don't have unlimited autonomy once you get into a value-based contract with five other providers," he said. "It's who do you want with you on the lifeboat? It matters who's with you in that group."

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